title: Impairment of contrast visual acuity as a functional correlate of retinal nerve fibre layer thinning and total macular volume reduction in multiple sclerosis.
abstract: OBJECTIVE
  To analyse the association between retinal nerve fibre layer thickness (RNFLT) and total macular volume (TMV) as measured by optical coherence tomography, and contrast sensitivity (CS) measured by Functional Acuity Contrast Testing (FACT) in relapsing-remitting multiple sclerosis; and to investigate whether FACT testing by a contrast box device is feasible in multiple sclerosis (MS).
  
  
  METHODS
  fact was performed using the Optec 6500 P vision testing system with best correction under photopic and mesopic conditions without glare. The Area Under the Log Contrast Sensitivity Function (AUC) was calculated. RNFLT and TMV were assessed by Stratus optical coherence tomography. All participants underwent visual acuity testing (Snellen), spherical refractive error testing and cylindrical refractive error testing.
  
  
  RESULTS
  85 relapsing-remitting multiple sclerosis patients (170 eyes) and 35 healthy controls (HC, 70 eyes) were measured. AUC Day and Night were lower in MS than in HC (p<0.001) when correcting for age, as were mean RNFLT and TMV (p<0.001 and p=0.018, respectively). Both RNFLT and TMV predicted contrast sensitivity in MS (AUC Day: standardised coefficient β=0.277, p<0.001, and β=0.262, p<0.001, respectively; AUC Night: β=0.202, p=0.009 and β=0.222, p=0.004, respectively, linear regressions). In HC, there was no correlation between RNFLT or TMV and contrast sensitivity.
  
  
  CONCLUSIONS
  (1) Contrast sensitivity is reduced in MS versus HC; (2) RNFL and TMV as morphological measures of retinal axonal loss are predictors of contrast sensitivity as a functional visual parameter in MS but not in HC; and (3) FACT with the contrast box is a novel, feasible and rapid method to assess contrast sensitivity in MS.
authors.affiliation: NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Charitplatz 1, 10117 Berlin, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Bock
authors.forename: Alexander U
authors.initials: AU
authors.lastname: Brandt
authors.forename: Jörn
authors.initials: J
authors.lastname: Kuchenbecker
authors.forename: Jan
authors.initials: J
authors.lastname: Dörr
authors.forename: Caspar F
authors.initials: CF
authors.lastname: Pfueller
authors.forename: Nicholetta
authors.initials: N
authors.lastname: Weinges-Evers
authors.forename: Gunnar
authors.initials: G
authors.lastname: Gaede
authors.forename: Hanna
authors.initials: H
authors.lastname: Zimmermann
authors.forename: Judith
authors.initials: J
authors.lastname: Bellmann-Strobl
authors.forename: Stephanie
authors.initials: S
authors.lastname: Ohlraun
authors.forename: Frauke
authors.initials: F
authors.lastname: Zipp
authors.forename: Friedemann
authors.initials: F
authors.lastname: Paul
mesh_terms: D000328:Adult; D015350:Contrast Sensitivity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016014:Linear Models; D008266:Macula Lutea / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000473:pathology*; D009412:Nerve Fibers / Q000473:pathology / Q000502:physiology; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D014792:Visual Acuity; D055815:Young Adult